AIM: To assess the effectiveness of selective laser trabeculoplasty(SLT)in the treatment of primary open angle glaucoma(POAG).METHODS:Totally 24 patients(33 eyes)with POAG who had poor control of intraocular pressure(IOP)from June 2022 to December 2023 were included in this retrospective study, and all of them were treated with SLT. Furthermore, the IOP, mean deviation(MD), mean sensitivity(MS), and the thickness and vascular density(VD)of optic disc nerve layer were compared after treatment. RESULTS: There were significant reducion in IOP at 1, 3, 6, 12 mo after treatment(all P<0.001). There were no statistically significant differences in MD and MS before treatment and at 6 and 12 mo after treatment(all P>0.05), and there were no statistical significant differences in the thickness and VD of optic disc(all P>0.05).CONCLUSION: SLT can significantly reduce IOP in POAG patients in the short term, without damaging the visual field and optic disc nerves, while the effectiveness of SLT decreases over time.

Background: Nasopharyngeal carcinoma (NPC) is characterized by high programmed death-ligand 1 (PD-L1) expression and abundant infiltration of non-malignant lymphocytes, which renders patients potentially suitable candidates for immune checkpoint blockade therapies. Palate, lung, and nasal epithelium clone (PLUNC) inhibit the growth of NPC cells and enhance cellular apoptosis and differentiation. Currently, the relationship between PLUNC (as a tumor-suppressor) and PD-L1 in NPC is unclear. Methods: We collected clinical samples of NPC to verify the relationship between PLUNC and PD-L1. PLUNC plasmid was transfected into NPC cells, and the variation of PD-L1 was verified by western blot and immunofluorescence. In NPC cells, we verified the relationship of PD-L1, activating transcription factor 3 (ATF3), and β-catenin by western blot and immunofluorescence. Later, we further verified that PLUNC regulates PD-L1 through β-catenin. Finally, the effect of PLUNC on β-catenin was verified by co-immunoprecipitation (Co-IP). Results: We found that PLUNC expression was lower in NPC tissues than in paracancer tissues. PD-L1 expression was opposite to that of PLUNC. Western blot and immunofluorescence showed that β-catenin could upregulate ATF3 and PD-L1, while PLUNC could downregulate ATF3/PD-L1 by inhibiting the expression of β-catenin. PLUNC inhibits the entry of β-catenin into the nucleus. Co-IP experiments demonstrated that PLUNC inhibited the interaction of DEAD-box helicase 17 (DDX17) and β-catenin. Conclusions PLUNC downregulates the expression of PD-L1 by inhibiting the interaction of DDX17/β-catenin in NPC.

Objective:To investigate the impact of tumor origin (ventral pancreatic origin and dorsal pancreatic origin) on prognosis in patients with pancreatic head cancer.Methods:A retrospective analysis was performed on the clinical data of 150 patients with pancreatic head cancer who received surgical treatment at the First Affiliated Hospital of the Naval Medical University from October 2014 to December 2017. Among these patients, 92 were male and 58 were female, aged (61.2±8.8) years. The 150 patients were divided into two groups based on tumor origin: the ventral pancreatic cancer group ( n=72) and the dorsal pancreatic cancer group ( n=78). A comparative analysis of clinical, pathological, and imaging charac-teristics was conducted between the two groups. Univariate and multivariable Cox proportional hazards models were used to analyze the association between pancreatic head cancer origin and overall survival (OS). Results:Patients with pancreatic head carcinoma arising from the ventral and dorsal pancreas accounted for 48%(72/150) and 52%(78/150) of the study cohort, respectively. Pancreatic head carcinoma arising from the dorsal pancreas were more likely to show pathological features of pancreatic parenchymal atrophy [73.1%(57/78) vs. 47.2%(34/72), χ2=10.49, P=0.001] and pancreatitis [44.9%(35/78) vs. 29.2%(21/72), χ2=3.95, P=0.047]. In contrast, patients with pancreatic head carcinoma arising from the ventral pancreas was more frequently associated with contact with the superior mesenteric artery [25.0%(18/72) vs. 1.3%(1/78), χ2=19.04, P<0.001], perineural invasion [100%(72/72) vs. 88.5%(69/78), χ2=8.84, P=0.003], and positive surgical margins [15.3%(11/72) vs. 2.6%(2/78), χ2=7.65, P=0.006], with all differences statistically significant. The ventral pancreatic cancer group demonstrated cumulative survival rates of 33.2% and 0 at 1-year and 2-year postoperative intervals, respectively, while the dorsal pancreatic cancer group exhibited rates of 56.7% and 24.8% at the corresponding timepoints. Comparison of Kaplan-Meier survival curves between the two groups showed a statistically significant difference ( χ2=6.00, P=0.014). Multivariable Cox proportional hazards analysis identified dorsal pancreatic origin pancreatic head cancer as an independent predictor of increased mortality risk compared to ventral origin tumors ( HR=2.75, 95% CI: 1.52-4.98, P=0.001). Conclusion:The embryonic origin of pancreatic head cancer determines its clinical, pathological, and imaging heterogeneity, and pancreatic head cancer arising from the ventral pancreas demonstrates significantly worse prognostic outcomes compared to dorsal pancreatic origin.

Objective To conduct a scoping review of the application of gamification programs in exercise rehabilitation for knee osteoarthritis,examining the application carriers,game content,outcome indicators,measurement tools,and application effects of gamification programs,to provide references for future practice and related research in this field.Methods The search was conducted in PubMed,Web of Science,Cochrane Library,Scopus,CIN AHL,China National Knowledge Infrastructure,CNKI,and Wanfang Data from their inception to December 28,2024.The included studies were summarized and analyzed.Results A total of 28 studies were included in the review.The game carriers encompassed virtual reality technology,sensor devices,and mobile applications.The game content covered interactive motion games,aerobic exercises,and goal-motivated games.Outcome indicators included functional performance,physical activity,pain,psychological and health status,and user experience.Gamification programs were found to effectively enhance user engagement,improve physical function,reduce negative emotions,and improve quality of life.However,there remains controversy regarding their efficacy in pain relief.Conclusion Gamification programs have shown positive effects in exercise rehabilitation for knee osteoarthritis.Future efforts should focus on developing gamification programs that are culturally appropriate for China,creating"digital therapeutics",continuously updating systems,conducting economic evaluations,and ensuring digital equity to enhance patients'rehabilitation experiences and improve health outcomes.

Objective:To investigate the role of human dermal microvascular endothelial cells(HMEC-1)exosome hsa-miR-4488_L in regulating the osteogenic and lipogenic differentiation of bone marrow mesenchymal stem cells(BMSCs)and to elucidate the mechanism of action underlying fate differentiation.Methods:The hsa-miR-4488_L mimic or negative control mimic was transfected into BMSCs, which were then cultured under osteogenic or lipogenic conditions, respectively.RT-qPCR was employed to detect the mRNA expression levels of osteogenic and lipogenic genes in BMSCs.Alizarin red staining was utilized to assess the osteogenic differentiation capability of hsa-miR-4488_L in BMSCs, while oil red O staining was used to evaluate the lipogenic differentiation potential of BMSCs.The mimic control and hsa-miR-4488_L mimic were transfected into elderly BMSCs, and age-related phenotypes were assessed using RT-qPCR and SA-β-gal staining.The direct target genes of hsa-miR-4488_L acting on BMSCs were identified through bioinformatics analysis and subsequently validated by RT-qPCR and Western blot.Results:After treatment with the hsa-miR-4488_L mimic, the expressions of osteogenic-related genes ALP( P=0.007), BSP( P=0.001), and Col1( P<0.001)in BMSCs were upregulated.Additionally, alizarin red staining results indicated an increase in the number of calcified nodules Pparγ( P=0.002).Concurrently, under adipogenic induction conditions, the adipogenic-related genes Pparγ( P=0.008)and Perilipin( P<0.001)were significantly downregulated in the hsa-miR-4488_L mimic treatment group, and oil red O staining demonstrated a reduction in lipid droplet production( P=0.032).The mRNA expression of the aging-related gene P16( P=0.009)was downregulated following treatment with the hsa-miR-4488_L mimic, and the number of senescent cells decreased as indicated by SA-β-gal staining.Bioinformatics analysis revealed that Smad3 was the direct target gene of hsa-miR-4488_L in BMSCs.RT-qPCR results confirmed that the expression of Smad3 was downregulated after treatment with the hsa-miR-4488_L mimic( P=0.040).Furthermore, Western blot analysis showed a reduction in the protein level of Smad3. Conclusions:HMEC-EXOs-derived hsa-miR-4488_L regulates the balance between osteogenic and adipogenic differentiation in BMSCs through Smad3.Consequently, hsa-miR-4488_L may serve as a potential miRNA biomarker for age-related osteoporosis.

Objective:To evaluate the role of interferon gene stimulator/long-chain ester acyl-CoA synthetase 4 (STING/ACSL4) signaling pathway in alleviation of oxygen-glucose deprivation and restoration (OGD/R)-induced ferroptosis in renal tubular epithelial cells.Methods:The close juxial tubule epithelial cells of human renal cortex were selected and divided into 9 groups ( n=78 each) using a random number table method: control group (C group ), OGD/R group, OGD/R + 25 μmol/L ciprofol group (HC25 group), OGD/R + 50 μmol/L ciprofol group (HC50 group), OGD/R + 100 μmol/L ciprofol group (HC100 group), virus control (NC) group, OGD/R + NC group, OGD/R + ciprofol + NC group (OGD/R+ Cip+ NC group), and OGD/R + ciprofol + STING overexpression lentivirus group (OGD/R+ Cip+ OE-STING group). The OGD/R model was developed by subjecting the cells to O 2-glucose deprivation (OGD) for 4 h followed by restoration of O 2-glucose supply for 20 h. Ciprofol at a final concentration of 25, 50 and 100 μmol/L was added to the medium during OGD/R in HC25, HC50, and HC100 groups, respectively. The cells were subjected to conventional culture after infection with the control virus of the STING overexpression lentivirus in NC group. The OGD/R model was developed after the cells were infected with control virus in OGD/R+ NC group. In OGD/R+ Cip+ NC group and OGD/R+ Cip+ OE-STING group, the cells were infected with control virus and STING overexpression lentivirus, respectively, and ciprofol 50 μmol/L was added to the medium during OGD/R. Cell damage parameters included the cell viability and activity of lactic dehydrogenase (LDH) in supernatant. The oxidative stress parameters included the activity of reactive oxygen species (ROS) and contents of malondialdehyde (MDA) and glutathione (GSH). Mitochondrial damage parameters included the mitochondrial area and branch length, content of mitochondrial 8-hydroxydeoxyguanosine (8-OHdG) in mitochondrial DNA (mtDNA), and DNA expression of nicotinamide adenine dinucleotide dehydrogenase 1 and 2 (mtND1, mtND2) and cytochrome oxidase (COX-1). The ferroptosis parameters included Fe 2+ content and expression of STING, ACSL4, nuclear factor-κB (NF-κB), cyclic GMP-AMP synthase (cGAS), and glutathione peroxidase 4 (GPX4) protein and mRNA. Results:Compared with group C, the activity of LDH in the supernatant was significantly increased, the cell viability was decreased, the ROS activity, MDA content, and Fe 2+ content were increased, the GSH content was decreased, the expression of ACSL4, cGAS, STING, NF-κB protein and mRNA was up-regulated, the expression of GPX4 protein and mRNA was down-regulated, the content of 8-OHdG in mtDNA was increased, the DNA expression of cytoplasmic mtND1, mtND2 and COX-1 was up-regulated, and the mitochondrial area and branch length were increased in group OGD/R ( P<0.05). Compared with OGD/R group, the cell viability and GSH content were significantly increased, the MDA content and Fe 2+ content were decreased, the expression of ACSL4, cGAS, STING, NF-κB protein and mRNA was down-regulated, the expression of GPX4 protein and mRNA was up-regulated, the content of 8-OHdG in mtDNA was decreased, and the DNA expression of cytoplasmic mtND1, mtND2 and COX-1 was up-regulated in HC50 group ( P<0.05). Compared with OGD/R+ Cip+ NC group, the cell viability was significantly decreased, the ROS activity was increased, the expression of ACSL4, cGAS and NF-κB protein and mRNA was up-regulated, the expression of GPX4 protein and mRNA was down-regulated, and the DNA expression of cytoplasmic mtND1, mtND2 and COX-1 was up-regulated in OGD/R+ Cip+ OE-STING group ( P<0.05). Conclusions:Ciprofol may exert cytoprotective effects by alleviating ferroptosis during OGD/R in renal tubular epithelial cells by inhibiting STING/ACSL4 signaling pathway.

Objective:To investigate the status of allostatic load (AL) in patients with polycystic ovary syndrome (PCOS) and its influence on the clinical outcomes of in vitro fertilization-embryo transfer.Methods:This was a prospective study. By using convenient sampling method, 421 patients with PCOS (PCOS group) and 372 control infertility patients (control group) in the Reproductive Center of the First Affiliated Hospital of Anhui Medical University from April 2022 to January 2024 were investigated for basic information, physical examination, laboratory examination and follow-up of clinical outcomes. The total score of AL was calculated using 16 related indicators of cardiovascular system, metabolic system and immune system, and AL>3 was used as the judgment criteria for the high level AL group and the low level AL group. The differences in general data, embryo development and clinical outcomes between the groups were compared.Results:There were 222 cases (52.7%, 222/421) in PCOS low level AL group and 199 cases (47.3%, 199/421) in PCOS high level AL group. There were 214 patients (57.5%, 214/372) in the control low level AL group and 158 patients (42.5%, 158/372) in the control high level AL group. Embryo development outcomes: number of oocytes retrieved (median: 12, 12, 19, 14, respectively; P<0.001), number of two pronuclei (median: 8, 7, 11, 8, respectively; P<0.001), number of fertilization (median: 9, 9, 13, 10, respectively; P<0.001), number of metaphase of meiosis Ⅱ oocytes (median: 9, 8, 13, 10, respectively; P<0.001), number of transferable embryos (median: 5, 5, 7, 6, respectively; P<0.001), number of high-quality embryos (median: 4, 3, 6, 5, respectively; P<0.001), gonadotropin(Gn) starting dosage (median: 150, 200, 150, 200 U, respectively; P<0.001), total dosage of Gn (median: 1 800, 2 075, 1 575, 2 025 U, respectively; P<0.001), duration of Gn used (median: 10, 10, 10, 10 days, respectively; P=0.027) in the control low level AL group, control high level AL group, PCOS low level AL group and PCOS high level AL group were significantly different. Pairings between groups showed that number of oocytes retrieved, number of two pronuclei, number of fertilization, number of metaphase of meiosis Ⅱ oocytes and number of transferable embryos in PCOS high level AL group were lower than those in PCOS low level AL group (all P<0.05); Gn starting dosage and total dosage of Gn in PCOS low level AL group were lower than those in the other three groups (all P<0.05); duration of Gn used in PCOS high level AL group was higher than that PCOS low level AL group ( P<0.05). Clinical outcomes: the control low level AL group, control high level AL group, PCOS low level AL group and PCOS high level AL group underwent fresh transplantation [27.4% (57/208), 24.4% (38/156), 15.1% (32/212), 17.1% (33/193), respectively; P=0.006] and the proportion of transplanted day 5 embryos [82.7% (172/208), 77.6% (121/156), 91.0% (193/212), 86.5% (167/193), respectively; P=0.018] were statistically significant. There were no significant differences in fertilization rate, biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate and early abortion rate among the four groups (all P>0.05). Conclusion:The high level of AL in PCOS patients may affect the outcomes of embryo development, and more attention should be paid to AL in PCOS patients to reduce stress.

OBJECTIVES: This study aims to explore the potential relationships of cell-free DNA (cfDNA) in gingival crevicular fluid (GCF) with periodontal clinical indicators and the expression of DNA receptor pathway cyclic guanosine phosphate-adenosine phosphate synthase (cGAS)-stimulator of interferon genes (STING) in gingival tissues and human gingival fibroblasts (HGFs). METHODS: GCF and gingival tissue samples were collected from periodontally healthy individuals and patients diagnosed with periodontitis. Periodontal clinical indicators were recorded, including plaque index (PLT), bleeding index (BI), probing depth (PD), and clinical attachment level (CAL). The concentration of cfDNA in GCF was quantified, and the correlation between GCF and periodontal clinical indicators was analyzed. Immunofluorescence and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were used to assess the distribution of cGAS, STING, and p-STING in gingival tissues. Additionally, the mRNA expression levels of the key components of the cGAS-STING signaling pathway, namely, cGAS, STING, inhibitory of kappa-B kinase (IKK), nuclear factor kappa-B p65 (NF-κB p65), interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α), were measured. Furthermore, cfDNA extracted from GCF was employed to stimulate HGFs in the healthy control and periodontitis groups, and the mRNA expression levels of the key molecules of cGAS-STING signaling pathway were detected through Western blot and RT-qPCR. RESULTS: The concentration of cfDNA in GCF was found to be significantly elevated in the periodontitis group compared with the control group. Moreover, cfDNA concentration demonstrated a strong positive correlation with the periodontal clinical indicators. Immunofluorescence analysis revealed considerably increased percentage of fluorescence co-localization of cGAS, STING, and p-STING with the gingival fibroblast FSP-1 marker in the gingival tissues of the periodontitis group. The mRNA expression levels of cGAS, STING, IKK, NF-κB p65, IL-1β, IL-6,and TNF-α were significantly higher in the periodontitis group. In vitro stimulation of HGFs with GCF-derived cfDNA resulted in increased protein expression of cGAS and p-STING and considerably upregulated the mRNA expression levels of cGAS, STING, IKK, NF-κB p65, IL-1β, IL-6, and TNF-α in the healthy and periodontitis groups compared with the blank group. Correlation analysis showed that the concentration of cfDNA at the sampling site was positively correlated with the mRNA expression levels of cGAS, STING, NF-κB p65, and IL-6 in gingival tissues. CONCLUSIONS cfDNA concentrations in the GCF of patients with periodontitis are considerably elevated, and are associated with the activation of the cGAS-STING signaling pathway in HGFs. These findings suggest that cfDNA contributes to the progression of periodontitis.
Humans ; Gingival Crevicular Fluid/metabolism* ; Signal Transduction ; Gingiva/cytology* ; Nucleotidyltransferases/genetics* ; Membrane Proteins/genetics* ; Cell-Free Nucleic Acids/analysis* ; Fibroblasts/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Periodontitis/metabolism* ; Interleukin-1beta/metabolism* ; Interleukin-6/metabolism* ; Adult ; RNA, Messenger/metabolism* ; Male ; Female

Objective To explore the sex differences in drug metabolism of sufentanil in Chinese patients based on the mutation classification of cytochrome P450 3A(CYP3A)enzymes.Methods According to the possible effects of combined cytochrome P450 3A4 gene*1G locus(CYP3A4*1G)and cytochrome P450 3A5 gene*3 locus(CYP3A5*3)mutation groups on Chinese population,we added different weights to CYP3A4*1G and CYP3A5*3 polymorphisms and classified patients into 3 groups:GroupⅠ,patients carried either the CYP3A4*1G/*1G allele or both CYP3A4*1/*1G allele and CYP3A5*3/*3 allele;Group Ⅱ,patients with both CYP3A4*1/*1G allele and CYP3A5*1/*3 allele;Group Ⅲ,patients with either the CYP3A4*1/*1 allele or both CYP3A4*1/*1G allele and CYP3A5*1/*1 allele.A single-dose,double-blind,stratified random sampling was performed,and 255 patients undergoing endoscopic surgery in the First Affiliated Hospital of Army Medical University were finally subjected.According to the results of genetic testing,an independent statistician,before operation,randomly selected 30 patients from each stratified group to form a study cohort(male-female ratio of 1∶1)and named each group A,B or C.Clinical investigators and subjects kept double-blind to the results of grouping and genetic testing.After entering the operating room,the subjected 90 patients received a single dose of sufentanil followed by collection of blood samples at 10 time points including 2 min before and from 2 to 120 min after administration.After the surgery,we determined the plasma drug concentration,calculated the pharmacokinetic parameters,and compared the metabolic differences between different genders in each group and unblinded the study.Results The cohort best fitted the two-compartment pharmacokinetic model,and groups A,B and C corresponded to group Ⅰ,Ⅱand Ⅲ,respectively.In different patient groups based on mutatron types of CYP3A enzymes the females had lower plasma drug concentration-time curves at each time point,higher systemic clearance(P≤0.01)and smaller area under the plasma concentration-time curve from zero to infinity(P＜0.05)when compared with the males.In addition,in group Ⅰ,the elimination rate of central compartment and movement rate of drug from central compartment to peripheral compartment were obviously greater in the females than the males(P＜0.05),while the distribution half-life(P＜0.05)and elimination half-life(P＜0.01)were notably longer in the males than the females.In both group Ⅱ and group Ⅲ,the males obtained larger total area under the plasma concentration-time curve than the females(P＜0.05).Conclusion There are sex differences in the drug metabolism of sufentanil in Chinese patients.Women show faster distribution and higher clearance of sufentanil while men present greater drug exposure.Preoperative CYP3A genotyping and intraoperative personalized medication are of great significance to ensure the safety in clinical practice.

ObjectiveTo study the relationship between qi stagnation constitution and suboptimal health status (SHS) or lifestyle.MethodsFrom 2012 to 2013, we conducted a cross-sectional survey of 24 159 Chinese individuals aged 12–80 years. The qi stagnation constitution was assessed using the Constitution in Chinese Medicine Questionnaire. Health status was evaluated through medical records and the Subhealth Measurement Scale V1.0 (SHMS V1.0). Health-promoting lifestyles were measured using the Health-Promoting Lifestyle Profile II (HPLP-II).ResultsOf the 24 159 participants, 16.1% and 15.2% were classified as “always” and “sometimes” having the qi stagnation constitution, respectively. Those classified as “rarely” having the qi stagnation constitution scored higher on both the HPLP-II and SHMS V1.0. The participants classified as “always” having the qi stagnation constitution showed a significant association with SHS or disease compared to other imbalanced constitutions. Those in the “always” category were approximately 21 times more likely to be classified as having SHS (odds ratio [OR]: 21.17, 95% confidence interval [CI]: 15.74–28.45), whereas those in the “sometimes” category were approximately six times more likely (OR: 5.89, 95% CI: 5.04–6.90). Accordingly, the qi stagnation constitution score was significantly associated with the diagnosis of SHS, with an area under the curve of 0.77 (P .001). A score of 18.75 yielded the highest Youden Index (0.407), with a sensitivity of 60.5% and a specificity of 80.3%. Significant associations were observed between health-promoting lifestyles and qi stagnation constitution severity in an ordinal regression analysis (P .001). Protective factors included stress management (OR: 1.59), self-actualization (OR: 1.57), and exercise (OR: 1.36). In contrast, poorer interpersonal relationships (OR: 0.79), greater health responsibilities (OR: 0.86), and poorer nutrition (OR: 0.91) were associated with increased severity.ConclusionModulating the qi stagnation constitution through lifestyle interventions may help prevent the progression of SHS to disease, which aligns with core preventive principles in traditional Chinese medicine.